|
E9256 Aph Plt ACDA LR Irr BTD6
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758120
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$616.70 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
|
|
E9256 Aph Plt ACDA LR Irr BTD6
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758120
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$440.32 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$444.64
|
| Rate for Payer: Amerigroup Medicare |
$444.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$440.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.32
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.50
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$660.75
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E9257 Aph Plt ACDA LR Irr 1 BTD6
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758125
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$440.32 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$444.64
|
| Rate for Payer: Amerigroup Medicare |
$444.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$440.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.32
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.50
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$660.75
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E9257 Aph Plt ACDA LR Irr 1 BTD6
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758125
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$616.70 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
|
|
E9258 Aph Plt ACDA LR Irr 2 BTD6
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758113
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$440.32 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$444.64
|
| Rate for Payer: Amerigroup Medicare |
$444.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$440.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.32
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.50
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$660.75
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E9258 Aph Plt ACDA LR Irr 2 BTD6
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758113
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$616.70 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
|
|
E9259 Aph Plt ACDA LR Irr 3 BTD6
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758110
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$440.32 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$444.64
|
| Rate for Payer: Amerigroup Medicare |
$444.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$440.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.32
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.50
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$660.75
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E9259 Aph Plt ACDA LR Irr 3 BTD6
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758110
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$616.70 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
|
|
E9260 Aph Plt ACDA LR Irr BTD7
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758105
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$616.70 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
|
|
E9260 Aph Plt ACDA LR Irr BTD7
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758105
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$440.32 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$444.64
|
| Rate for Payer: Amerigroup Medicare |
$444.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$440.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.32
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.50
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$660.75
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E9261 Aph Plt ACDA LR Irr 1 BTD7
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758118
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$616.70 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
|
|
E9261 Aph Plt ACDA LR Irr 1 BTD7
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758118
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$440.32 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$444.64
|
| Rate for Payer: Amerigroup Medicare |
$444.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$440.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.32
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.50
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$660.75
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E9262 Aph Plt ACDA LR Irr 2 BTD7
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758123
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$616.70 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
|
|
E9262 Aph Plt ACDA LR Irr 2 BTD7
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758123
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$440.32 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$444.64
|
| Rate for Payer: Amerigroup Medicare |
$444.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$440.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.32
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.50
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$660.75
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E9263 Aph Plt ACDA LR Irr 3 BTD7
|
Facility
IP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758117
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$616.70 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
|
|
E9263 Aph Plt ACDA LR Irr 3 BTD7
|
Facility
OP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
8758117
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$440.32 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$444.64
|
| Rate for Payer: Amerigroup Medicare |
$444.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$440.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.32
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.50
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$660.75
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
Ear, Nose, Mouth and Throat Malignancy With CC
|
Facility
IP
|
$12,808.92
|
|
|
Service Code
|
MS-DRG 147
|
| Hospital Charge Code |
27
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,808.92 |
| Rate for Payer: Amerigroup Medicaid |
$12,747.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,623.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,808.92
|
|
|
Ear, Nose, Mouth and Throat Malignancy With MCC
|
Facility
IP
|
$20,015.53
|
|
|
Service Code
|
MS-DRG 146
|
| Hospital Charge Code |
26
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$20,015.53 |
| Rate for Payer: Amerigroup Medicaid |
$19,918.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,725.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,015.53
|
|
|
Ear, Nose, Mouth and Throat Malignancy Without CC/MCC
|
Facility
IP
|
$7,741.05
|
|
|
Service Code
|
MS-DRG 148
|
| Hospital Charge Code |
28
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,741.05 |
| Rate for Payer: Amerigroup Medicaid |
$7,703.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,628.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,741.05
|
|
|
EBV capsid antibody
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
8819615
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
EBV capsid antibody
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
8819615
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
ECG Monitor/Record <= 48 hrs Charge
|
Facility
IP
|
$375.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
4850266
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna of IA Commercial |
$337.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$337.50
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$281.25
|
| Rate for Payer: Medical Associates Commercial |
$281.25
|
| Rate for Payer: Midlands Choice Commercial |
$262.50
|
| Rate for Payer: United Healthcare Commercial |
$337.50
|
|
|
ECG Monitor/Record <= 48 hrs Charge
|
Facility
OP
|
$375.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
4850266
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$187.42 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna of IA Commercial |
$337.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$337.50
|
| Rate for Payer: Aetna of IA Medicare |
$213.75
|
| Rate for Payer: Amerigroup Medicaid |
$189.26
|
| Rate for Payer: Amerigroup Medicare |
$189.38
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$281.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$187.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$187.42
|
| Rate for Payer: Medical Associates Commercial |
$281.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$187.50
|
| Rate for Payer: Midlands Choice Commercial |
$262.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$190.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$281.25
|
| Rate for Payer: United Healthcare Commercial |
$337.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$221.25
|
| Rate for Payer: Wellmark IA HMO |
$281.48
|
| Rate for Payer: Wellmark IA PPO |
$309.63
|
|
|
ECG Monitor w/ Report <= 48 hrs Charge
|
Facility
OP
|
$375.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
4850275
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$187.42 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna of IA Commercial |
$337.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$337.50
|
| Rate for Payer: Aetna of IA Medicare |
$213.75
|
| Rate for Payer: Amerigroup Medicaid |
$189.26
|
| Rate for Payer: Amerigroup Medicare |
$189.38
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$281.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$187.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$187.42
|
| Rate for Payer: Medical Associates Commercial |
$281.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$187.50
|
| Rate for Payer: Midlands Choice Commercial |
$262.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$190.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$281.25
|
| Rate for Payer: United Healthcare Commercial |
$337.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$221.25
|
| Rate for Payer: Wellmark IA HMO |
$281.48
|
| Rate for Payer: Wellmark IA PPO |
$309.63
|
|
|
ECG Monitor w/ Report <= 48 hrs Charge
|
Facility
IP
|
$375.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
4850275
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna of IA Commercial |
$337.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$337.50
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$281.25
|
| Rate for Payer: Medical Associates Commercial |
$281.25
|
| Rate for Payer: Midlands Choice Commercial |
$262.50
|
| Rate for Payer: United Healthcare Commercial |
$337.50
|
|
